1. Child Whisperer: Behavior Modification Tools Anita R. Webb, PhD JPS Health Network Fort Worth, TX

2. GOAL Children who are content, productive, well-functioning, and competent Who will become content, productive, well-functioning, competent adults.

3. OBJECTIVES Understand the importance of structure for child development Familiarity with the potential benefits of nonphysical discipline Confidence in positive parenting skills

4. KEY POINTS Children need structure and consistency. Behavior modification skills provide tools for parents, teachers, physicians, etc. Behavioral skills are not complicated. Family physicians can teach parents some of these skills over the course of the child’s development.

5. The Question “What kinds of child rearing and nurturance lead to the development of the most: content, productive, well-functioning, and competent children and adolescents?”  (Kaslow 2001)

6. The Role of Discipline? “Next to love, a sense of discipline is a parent’s second most important gift to a child.” (Brazelton 1992)

7. Goals Of Discipline 1. Immediate goal: Security 2. Long range goal: Internalize the external control In order to achieve Self Control  “Self-discipline”

8. Afraid To Discipline However, today’s parents “are insecure and fear doing something wrong” in disciplining their children.

9. Parent Education Parents need information about Child development Importance of “structure” How to provide structure Discipline strategies: Rules, tools

10. DISCIPLINE Root word: “Disciplinare” “To teach or instruct” AAP Definition: “Consistent structure and teaching”

11. Discipline: Definitions Dictionary: 1. Training that strengthens 2. Correction 3. Punishment 4. Control or order maintained 5. A system of rules for conduct

12. Misbehavior Stressors can trigger misbehavior. Multiple potential stressors for children Family dynamics Peer problems School problems Abuse Psychological disorder Life events: loss, disaster, trauma, etc. Even normal developmental tasks of childhood

13. How to Help a Stressed Child Teach the child ways to deal with stress. Offer nurturance, support and reassurance. Provide structure: RULES Stressors can destabilize a child. Structure helps the child regain stability.

14. Example: Normal Development Each stage of child development presents a developmental TASK. The new task is demanding and requires all of the child’s energy. This leaves the child exhausted and easily frustrated. (Brazelton 1992)

15. Normal Regression So the child may briefly regress, and behavior becomes negative. This is a normal part of child development. How a parent handles this temporary regression can either facilitate or interrupt the child’s progress.

16. STRUCTURE Regression makes children anxious. Their negative behavior confuses and frightens them. So they seek external limits/structure. They will repeatedly provoke their parents until clear limits are provided. Discipline = “clear limits”

17. Physician’s Role: “Touchpoints” The child’s misbehavior provides an opportunity for the physician to “touch” the family during office visits: To offer support for parents and child To reassure and teach parents Which can prevent development of destructive parent/child patterns. (Brazelton 1992)

18. Teach the Parents Behavior Modification Skills Two Cardinal Rules Children tend to: 1. Continue behavior which is rewarded (reinforced). Note: Attention is especially rewarding. 2. Stop behavior which is ignored. (AAFP “Child Behavior” 2000)

19. Two Behavior Mod. Strategies 1. Increase desired behavior Through Reinforcement 2. Eliminate undesired behavior Multiple strategies Example: “Time-out”

20. Increasing Desired Behavior “Catch Them Being Good”: Pay Attention! Lots of praise, especially initially Redirecting: To acceptable behavior Modeling: Copy someone’s desirable behavior Parent, teacher, sibling, friend, etc. Cartoon, TV, movie character, etc. Requires positive relationship/perception

21. Increasing Desired Behavior (cont.) Structure: Rules, Routines With structure, kids know what is expected Predictability provides sense of security/safety Promote regular daily routines and rituals Facilitates cooperative behavior Requires consistency, self-discipline from parent Inconsistency creates confusion Confusion interferes with learning

22. Decreasing Undesired Behavior 1. REDIRECT: “Behavior substitution” Example: bang on drum instead of table 2. EXTINGUISH Ignore: Withhold your reinforcing attention Punish (next slide) (AAFP “Parenting Tips” 1999)

23. Punishment: Examples Loss of privileges Loss of freedom: “Grounding” Extra chores Time-out “Natural consequences” (age appropriate) The best teacher Do not rescue (unless there is danger!).

24. Nonphysical Punishment: Advantages Develops the child’s: (1) Cognitive skills Problem solving, reasoning, judgment (2) Communication and social skills Better relationships: parents, peers, society (3) Self-Control Ability to talk about issues instead of acting out in anger or withdrawing in frustration

25. Advantages (continued) (4) Emotional Growth & Maturity Better self-esteem due to experience of success Confidence in their judgment and skills Able to accept responsibility for the consequences of their decisions/choices Ability to behave differently the next time the issue comes up.

26. Punishment Example: Time-out Many parents have found time-out to be a useful technique. But most parents say that time-outs don’t change their children’s behavior. (Schwarzbeck 1979)

27. Time Out: Efficacy? Controversial: Complicated results “Most of the children I talked with told me that time-outs are really because “Their parents are mad at them and want to get away from them.” Kids say that time-out is “stupid and mean”. (Schwarzbeck 1979)

28. Consider Child’s Maturity Level Some children are less able to control their impulses because they are Less neurologically mature. Fatigue and boredom Often cause these children to feel disorganized and angry.

29. Time-Out Contra-indication “Children with underdeveloped nervous systems need enormous one-on-one help. “They cannot feel comfortable alone. “They need an involved, caring adult. “They need the opposite of time-out.” (Schwarzbeck)

30. Child Whisperer? Horse Whisperer Gentle training, requires great patience Dog Whisperer “A good obedience training program is the foundation for a life-long bond with your dog.” Does a child deserve less?

31. CONCLUSION Punishment, like rewards, must be individualized One-size does not fit every child in the family Consider each child’s Personality Developmental stage/maturity Cognitive, social, emotional, physical Personal and family history  e.g. Trauma

32. SUGGESTION Whenever possible, use positive methods to help children develop self-discipline. TEACH them using: Reinforcement: Kids want your attention Modeling: Peers, pets, parents, Big Bird, etc. Their cognitive skills: Develop their brains Teach child to consider potential positive and negative consequences of behavior.

33. Especially as kids get older: Talk with them about the stressor/problem. Teach them how to brainstorm about solutions. Ensure that they understand the outcomes and consequences of their behavior. But do NOT argue about the rules at the time of enforcement. When calm: Ask their opinion about punishment strategies and appropriate consequences.

34. SUMMARY Thoughtful, careful discipline can teach children: Self-control Interpersonal skills Communication skills Cognitive skills including good judgment Respect for others Social values

35. Key Points Children need structure and consistency. Behavior modification skills provide tools for parents, teachers, physicians, etc. Behavioral skills are not complicated. Family physicians can teach parents some of these skills over the course of the child’s development.

36. THE END